HealthcarePapers
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Outside hospitals, drug therapy is not universally insured by the Canadian public health care system. Coverage depends on choices made by the provincial and territorial governments in designing their pharmacare programs. A priority within the programs is ensuring that all Canadians have reasonable access to catastrophic drug coverage. ⋯ This commentary reviews evidence and experience from other countries in order to assess the options for a few key dimensions of expanding pharmacare coverage. These are: eligibility rules for individual coverage; drug assessment in terms of approval for coverage; medication management strategies; and finally ongoing program evaluation. Catastrophic drug coverage needs to be flexible to adapt to existing pharmacare programs and responsive to the competing demands for limited resources within the health care sector.
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Canada's public-private mix in coverage for pharmaceuticals has long created variation across provinces in access to needed treatments and has contributed to persistent cost growth in both the private and public sectors. Among the recommendations of the 2002 Romanow Commission was a proposed national standard for "last-dollar" pharmacare that would cover any household's drug costs beyond a high annual deductible. Such a program contrasts with the "first-dollar" pharmacare programs currently available for vulnerable populations (e.g., seniors and social assistance recipients) in most provinces. While last-dollar coverage may be a valuable set toward broadening public pharmacare in Canada, there is a risk that provincial governments may interpret the coverage of catastrophic costs as the new pharmacare ideal and therefore reduce or eliminate existing programs that currently offer first-dollar benefits.
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Howard Chodos and Jeffrey MacLeod offer a breath of fresh air, with their call for a pragmatic approach to decisions about the role of the private sector in the Canadian healthcare system. At the current rate of growth, Canadians will spend 125 billion Canadian dollars on health services this year. We have some decisions to make: the healthcare system is too big, too complex and too important for us to make those decisions based on preconceived notions or ideology.
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In Healing Medicare, Michael Decter (1994) quotes from a speech made in 1982 by Tommy Douglas: "When we began to plan medicare (35 years previously), we pointed out that it would be in two phases. The first phase would be to remove the financial barrier between those giving the service and those receiving it. The second phase would be to reorganize and revamp the delivery system--and of course, that's the big item. It's the big thing we haven't done yet."
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Comment
The public/private debate in the funding, administration and delivery of healthcare in Canada.
To help clarify the confusing debate concerning the public-private divide in Canada and the respective positions of the Romanow and Kirby reports, a new approach is proposed. The funding, administration and delivery of the healthcare "system" is split into distinct analytical categories and then applied to three major coverage groupings: universal public (Canada Health Act) coverage for medically necessary/required services; mixed coverage for drug care, home and long-term care; and private health goods and services. ⋯ In particular, the Romanow report recommended that home mental healthcare services become universally covered under the Canada Health Act as well as fundamental changes to the regulation and administration of prescription drug care. The reports also differed in terms of framing the private delivery question, with the Romanow report questioning whether the evidence justified private-for-profit delivery replacing current private not-for-profit or public arm's length delivery modes.